Thursday, November 5, 2020

Noridian MAC Announces Several COVID Test Prices

 Last spring, when the first AMA CPT COVID codes were created, CMS quickly asked its MACs to set prices for them, and CMS published the prices quickly.

For more recent codes, I don't think CMS has organized price publications as efficiently or with the same priority.  However, today at the California Clinical Lab Association meeting, Noridian MAC was asked if it had set prices for CPT COVID codes 87636, 81637, and 87811, and it quickly provided them.

Here's what I jotted down:

o   87811

§  Infectious agent antigen detection, direct optical ie visual, COVID 19

§  $41

o   87636

§  Infectious agent, DNA/RNA, COVID 19 + Infl A,B, Multiplex

§  $142

o   87637

§  Infectious agent, DNA/RNA, COVID 19, Infl A,B, and RSV, Multiplex

§  $142

See the October version of the AMA CPT code list for COVID, link below.  Check AMA regularly for updates.


In other CCLA meeting news, Noridian reiterated that it doesn't cover high-target respiratory virus codes, only 3-5 targets.   They noted they get some blowback on this, and that cases were marching into appeals.  I noted that to my eye, CMS has a publication listed the high-target respiratory viral codes as covered under CMS COVID policy, but (as Noridian reiterated) they are not covered by the Noridian MAC.  My blog here.